Adolescents' suicide risk and multimodal autonomic responses in three parent-child contexts

Parent-child conflicts are implicated in adolescents' suicide risk, while positive parent-child interactions appear protective. Understanding how adolescents at elevated risk respond to parent-child interactions could inform suicide prevention. Parent-child contexts provoke intricately patterned, parasympathetic and sympathetic autonomic responses, which are thought to facilitate situationally appropriate self-regulation but may be maladaptive when atypical. Examining interactions of baseline and task-related autonomic components has promise for identifying clinically relevant response profiles.

Participants were clinically referred adolescents (N = 162; M_age=12.03 yrs; 47% female; 60% minoritized race/ethnicity). Over half (61%; n = 99) were considered at elevated suicide risk based on suicide/self-harm thoughts/behaviors on any measure (self-report, interview, ecological momentary assessment). Adolescents completed three parent-child interaction tasks with differing self-regulation demands: a conflict discussion, a positive discussion, and a reading challenge. Autonomic responses were measured using respiratory sinus arrhythmia (RSA), cardiac pre-ejection period (PEP), and skin conductance level (SCL). Multivariate logistic regressions for each parent-child context predicted suicide risk status using task-related change in all autonomic indices in the context of (i.e., as moderated by) baseline autonomic activity.

Elevated suicide risk status was associated with context-specific, sympathetic patterns: pronounced threat-like (PEP) response to the conflict discussion, pronounced disengagement-like (SCL) response to the positive discussion, and an amotivation-like (PEP) response to the reading challenge. Results were independent of subjective affect covariates.

Autonomic dysregulation may help explain suicide risk. Findings are consistent with interpersonal suicide theories and may help pinpoint contextually bound interpersonal affective processes associated with youths' suicide risk.